Severe Adult Acute Epiglottitis

Abstract

Historically, acute epiglottitis occurred in young children and the most common causative organism was Haemophilus influenzae type b (Hib). Since the introduction of the Hib vaccine, the incidence of epiglottitis among children has declined, whereas the incidence among adults has increased. The typical profile of an adult patient with acute epiglottitis seems to be a middle-aged patient with a male predominance. Contrary to the classical presentation of epiglottitis in children, adult patients present with nonspecific oropharyngeal symptoms. Thus, diagnosis can be delayed or missed in its initial stage. Flexible laryngoscopy is used to confirm the diagnosis, showing inflammation of the epiglottis and the adjacent supraglottic structures. Most patients can be closely monitored in the Intensive Care Unit, without the need for an airway intervention. However, in severe epiglottitis, the focus of treatment is the maintenance of a patent airway, using intubation or tracheotomy. Mortality remains low, but hypoxic cardiac arrest can occur without warning, due to airway obstruction.